Feeling extremely underappreciated

Medic2RN_ · Nov 29, 2016

So, in my application it said : requirements, paramedic license of ____ state. Acls. PALS. NRP. I'm allowed to do other things that CNA's are not allowed to do in this ER. Let me clarify myself again, I don't have a problem doing my job. I have a problem with running ragged, as another member said, while someone sits on their phone viability on Facebook or gossips to another coworker about something while telling me to do this and do that. I understand what a nurse does. Not first hand, but my boyfriend is a nurse and I understand the amount of charting and busywork that comes with it.

Horseshoe, BSN, RN · Nov 29, 2016

So, in my application it said : requirements, paramedic license of ____ state. Acls. PALS. NRP. I'm allowed to do other things that CNA's are not allowed to do in this ER. Let me clarify myself again, I don't have a problem doing my job. I have a problem with running ragged, as another member said, while someone sits on their phone viability on Facebook or gossips to another coworker about something while telling me to do this and do that. I understand what a nurse does. Not first hand, but my boyfriend is a nurse and I understand the amount of charting and busywork that comes with it.

With all due respect, the fact that your boyfriend is a nurse does NOT give you the understanding of what it's like to be a nurse. Without having that experience, you just cannot know.

That said, if you are being asked to do more than it's possible for you to do, that is an issue that needs to be addressed. And you do NOT have to throw out criticisms of the nurses to make that point. Just as there is a point where a nurse to patient ratio can be unfair and more importantly, unsafe, you also have your limits, even if the nurses are not inappropriately delegating to you in terms of actual tasks and scope.

You need to address this with your supervisor. Limits need to be set and conveyed to the staff.

emmy27 · Nov 30, 2016

In defense of the OP- I have worked in several places where paramedics are employed to work with their full scope in the ED. It's super great, if your facilities are paying paramedics to be techs, tell management to get with the program and let them perform their full scope, it's a more sensible use of resources and it's good for patients and staff alike. It's not a crazy notion and I don't think the OP is confusing their job role.

To the OP- I have been a tech and I have been a floor nurse and I've been an ED nurse and I can promise you, however much work the nurses are delegating to you as a paramedic, and however much you perceive them to be goofing off, they are still doing a ton of work. I know this because I know exactly how many things a paramedic still isn't permitted to do in an ED setting that are required to get a patient from door to disposition. We recently trialed a plan in our department where rather than floating or tasking, paramedics took teams similar to nurses (within a certain acuity of patient), and even for our experienced medics who have worked in this department for years, the orientation to get them to where they needed to be to be responsible for patients from beginning to end was intense, and there's still a list of things they need to pull a nurse to do (either for training or licensure scope reasons).

Yes, nurses can do everything you can do in that setting but there are still many things you are not allowed to do (things you may not even be aware are being done at all) and that's the nature of delegation- you're there in part to relieve pressure on people who have a larger scope of practice than you do, by taking up slack from their huge slate of responsibilities. It sometimes makes you feel a bit like the bottom of the hill down which certain substances are notorious for rolling, I know.

I understand the frustration of being overwhelmed with tasks (I've been there) but it's also important to remember that a. you don't have a full picture of what is going on in the department and with other workers and b. *they also* don't have a full picture of what you're doing. If people ask you to do different things simultaneously, it's not just okay but essential to communicate that- things like "Yes, I can get that splint, but not until I'm done with this EKG. If you want to do the EKG, I can get to the splint immediately," or "I'm sorry, I've already agreed to do four sets of stat blood work, I can't get vitals right now."

Just assuming impossible amounts of work without clarifying when you need help or what you're already doing builds resentment, burns you out, and can actually be bad for the unit and the patients (if you wind up delaying care by agreeing, however resentfully, to more work than you can do).

But also consider that this really is a little foretaste of nursing, but without much of the mental exhaustion and anxiety that comes from being not just expected to do frequently impossible or incompatible lists of tasks, but also from being responsible for a thousand decisions, big and small, every day, split among multiple patients with competing needs simultaneously. I was often frustrated as a tech, feeling that everyone was pulling me in a thousand different directions. Once I became a nurse, I was ever so slightly nostalgic for those days, when even if everyone was telling me what to do, hey, at least *someone was telling me what to do.*

Good luck.

Kooky Korky, BSN, RN · Nov 30, 2016

Usually Triage/do vitals when they first come in. IV's. Blood work. Help hold down to give shots. Let me clarify. I don't have a problem doing vitals and triaging and IV's. (I have PALS NRP and ACLS) during times when we get a rescue and do the EKG, all of that stuff. I do assess and hand off to the nurse and they choose either to assess for themselves or take what I give them. I don't have a problem doing my job, I love kids and I love my job. (My unit doesn't even transfer a lot. It's mostly kids with just fever or something else like strep) it just bothers me when I'm used like a pawn and I'm not called by my job title. It bothers me even more when people are sitting around gossiping and 4 nurses are telling me at once to recheck vitals and do a splint or whatever while they're all sitting, talking, gossiping. I think what I was posting didn't get accross to some people. I think whoever it is. The paramedic, CNA, MD whatever all of us need to work together. I shouldn't be abused and neither should the nurse by the doctor. I'm only one person. I can't do 4 kids vital signs at once and do this line for one kid and this other thing. It would just be nicer if one of them did like a part of that so I'm not running around like a crazy person.

Maybe you could just calmly, courteously say to the people telling you to do all of these things "I have been assigned by Susie to do X, then by Nancy to do Y, and by Abby to do Z. It will take about 20 minutes. If you, Juliette or you, Romeo need D sooner than that, you will need to do it". Then stand by that a few times and they will start to get the message that you only have 2 hands.

And just say "I need to eat because I feel faint from hunger" when you need to eat. Or "I'm about to wet my drawers" when the old bladder is bursting.

In other words, communicate. Don't just bottle it all up and feel victimized without trying to change the work setting.

Medic2RN_ · Nov 30, 2016

In defense of the OP- I have worked in several places where paramedics are employed to work with their full scope in the ED. It's super great, if your facilities are paying paramedics to be techs, tell management to get with the program and let them perform their full scope, it's a more sensible use of resources and it's good for patients and staff alike. It's not a crazy notion and I don't think the OP is confusing their job role.
To the OP- I have been a tech and I have been a floor nurse and I've been an ED nurse and I can promise you, however much work the nurses are delegating to you as a paramedic, and however much you perceive them to be goofing off, they are still doing a ton of work. I know this because I know exactly how many things a paramedic still isn't permitted to do in an ED setting that are required to get a patient from door to disposition. We recently trialed a plan in our department where rather than floating or tasking, paramedics took teams similar to nurses (within a certain acuity of patient), and even for our experienced medics who have worked in this department for years, the orientation to get them to where they needed to be to be responsible for patients from beginning to end was intense, and there's still a list of things they need to pull a nurse to do (either for training or licensure scope reasons).
Yes, nurses can do everything you can do in that setting but there are still many things you are not allowed to do (things you may not even be aware are being done at all) and that's the nature of delegation- you're there in part to relieve pressure on people who have a larger scope of practice than you do, by taking up slack from their huge slate of responsibilities. It sometimes makes you feel a bit like the bottom of the hill down which certain substances are notorious for rolling, I know.
I understand the frustration of being overwhelmed with tasks (I've been there) but it's also important to remember that a. you don't have a full picture of what is going on in the department and with other workers and b. *they also* don't have a full picture of what you're doing. If people ask you to do different things simultaneously, it's not just okay but essential to communicate that- things like "Yes, I can get that splint, but not until I'm done with this EKG. If you want to do the EKG, I can get to the splint immediately," or "I'm sorry, I've already agreed to do four sets of stat blood work, I can't get vitals right now."
Just assuming impossible amounts of work without clarifying when you need help or what you're already doing builds resentment, burns you out, and can actually be bad for the unit and the patients (if you wind up delaying care by agreeing, however resentfully, to more work than you can do).
But also consider that this really is a little foretaste of nursing, but without much of the mental exhaustion and anxiety that comes from being not just expected to do frequently impossible or incompatible lists of tasks, but also from being responsible for a thousand decisions, big and small, every day, split among multiple patients with competing needs simultaneously. I was often frustrated as a tech, feeling that everyone was pulling me in a thousand different directions. Once I became a nurse, I was ever so slightly nostalgic for those days, when even if everyone was telling me what to do, hey, at least *someone was telling me what to do.*
Good luck.

Thank you for explaining to me this not only in a nice way but making a good picture of it. I've had a few people on here get NASTY with me when I don't think I really deserved it. Thank you for sending me luck! You too! Everyone needs it in this line of work !!!!!

MarisL · Nov 30, 2016

Maybe you could just calmly, courteously say to the people telling you to do all of these things "I have been assigned by Susie to do X, then by Nancy to do Y, and by Abby to do Z. It will take about 20 minutes. If you, Juliette or you, Romeo need D sooner than that, you will need to do it". Then stand by that a few times and they will start to get the message that you only have 2 hands. And just say "I need to eat because I feel faint from hunger" when you need to eat. Or "I'm about to wet my drawers" when the old bladder is bursting. In other words, communicate. Don't just bottle it all up and feel victimized without trying to change the work setting.

Excellent advice. First and foremost: Thank you for all you do. You definitely are a valuable worker, and the job you do matters greatly.

When the CNA in my area is working as hard as I am, it makes things so very much better for our patients.

A nurse sitting at their computer is likely a very busy person. If you go the RN route, you will get a first hand look at that one real fast. I hope you choose to go all the way to get your RN, as your prior education and experience will be invaluable to your facility and patients.

From your post, I read you as a person who has a high ethical standard for doing your job. The nurses around you do too, but what they do can be less obvious. I'm sorry that you haven't been told this more often, because you deserve to be, but Thank You for your contribution to the team. It makes a world of difference in your patients' hospital experience. I've seen a single interaction by a non RN change a patient's C+ hospital experience into an A+ experience, through use of AIDET.

Since you have mentioned RNs sitting as an irritant, I'd like to share from my experience, if I may.

A nurse who is sitting at their computer is almost always working very hard indeed.

He or she also has to be able to drop their computer-sitting charting etc. at a moments notice, for prn requests, toileting, IV pump error messages, bed alarms, tele calls, and what I'd call 'the works. Some examples include:

Aside from the reams of mandatory charting (including charting at least 9 descriptive markers regarding the quality of the patient's pain for each pain med given), additionally the nurse is responsible for knowing and monitoring what the patient is there for, what symptoms to be especially vigilant for, what the doctor is aware of and what s/he needs to know but doesn't (yet), whether all the doc's orders are being done, getting new orders as appropriate, what the patient's trend is on each of the conditions they came in with or developed, making sure that critical labs are getting done timely and evaluated timely, assessing standard vitals and labs and imaging (and all the rest), tracking down the physical location where a needed medicine is, doing mandated dual hand-offs on meds per policy, ensuring that standard things like reasonable food and fluids intake and urine output is in the appropriate range, keeping an eye on the pt's IV sites and seeing that they get new one IVs as needed, blood draws, researching whether the patient got sun-downy the night before too, seeing if their HR runs low at night as a baseline, checking out anyone who has a non standard VS and if needed taking action to fix it, making sure the pt's at home med list lines up with their hospital list appropriately, staying on top of IT's interface changes, doing quality checks on machines, doing narcotic counts, documenting what med/intervention you gave where and why and what effect it had, finding missing necessary equipment, trouble shooting it, juggling admits, transfers and discharges, making sure the patient is heading to the right kind of place (home, SNF, rehab, etc) with the right follow up ...

We are also expected to know how to contact doctors as needed (can be a research project) and following through, making sure that all the orders are appropriate for the situation. We have to look out for med interactions, and compare labs to the pt's meds and diagnosis. We are out patient's advocates. We have to answer calls from family members (with Hipaa correctness.)

We have to document all of this. We have to keep an eye out for orders popping up unannounced, and ensure set up and appropriate completion of all orders.

We have to be constantly looking ahead as well: We began working on discharge from the moment the patient came in, appropriateness, safety, and getting everyone on the same page for that time.We must meet the pt's education needs.

The things listed here are literally just the beginning of our responsibilities to the patient. That list may be informative the next time you see a nurse "just sitting" at their computer.

Which is all perhaps informative, but not really what you need to hear. That list doesn't address the feelings behind your post.

I hope that this does:

If you are getting more requests for assist/vitals/etc. than you can accommodate, definitely try just letting the requesting nurses know what you are doing, and when you'll be free to help them. Stick to what is realistically possible. Prioritize stat needs. If you are just too busy for a stat-request job, just clearly say so. The nurse will do it herself, or ask another floor nurse or helper to do it, or call the charge RN for help.

If you are catching flack for not being able to be everywhere always for everyone, and calm explanations haven't eased your situation, I think you should talk with your manager. I think that with a forthright 'request reply' such as "I' doing x and y, I can do those vitals for you after that in about z minutes" you will (I hope) find the job becomes more tolerable.

Good team members are priceless. Your extra achievements are so valuable to your floor you are on.

Wishing you all the best, congrats on your accomplishments, and Best of Luck.

Amethya · Nov 30, 2016

This sounds like my old job. I was there for a year and I was forced to do most of the labor around, while everyone was on their phone or sitting. I never had any health problems until this job, where one day I just got up from the toilet, and I got the most intense electric pain in my lower back, down my R buttocks, R leg, foot and arch. It was so painful to sit down, but I sucked it up and thought it will go away after sleeping.

But sadly it was worse the next day and as much as I tried to suck it up at work, I couldn't and left early to see my doctor. X-Rays were done, nothing showed. But was told to take it easy and if it happens again, we may do MRIs or other testing. If it looks bad, we may do surgery. Was given Ibuprofen and as the week went by, the pain left. I was scared it would happen again, so I asked if I can have small breaks between patients to sit on the chair while charting, because that scared me and I seriously do not want surgery. They told me no, and to suck it up. So while I didn't have the pain again, the other girls were allowed to sit and do what they wanted, while I was scolded for everything.

jky004 · Nov 30, 2016

I'm not sure as to why people are getting so defensive for these nurses you do not know. Many of you have told her that she's only been working there three months so its too early to judge these people.. you guys don't even know them, a profession does not necessarily say anything about their personalities... they may be a nurse and a lazy person who loves to sit around and gossip.. it's possible people. I'm in nursing school right now and work as a tech and can say that without a doubt there are quite a few nurses who are not on their computer (therefore not charting) and sit there actually with earphones in watching HBO or Netflix.. some even leave their stations to go gossip at the front desk for 30 min at a time.. it's very possible that she is not wrong about their negligence and it seems wrong that many comments on here completely neglect (funny) her statements about how her coworkers are simply chit-chatting and not charting... you can tell the difference very easily.. So I'm done venting for this individual and I hope everything get better, honey! Just get through school and it will all be worth it :) Best of luck!

Horseshoe, BSN, RN · Nov 30, 2016

I'm not sure as to why people are getting so defensive for these nurses you do not know. Many of you have told her that she's only been working there three months so its too early to judge these people.. you guys don't even know them, a profession does not necessarily say anything about their personalities... they may be a nurse and a lazy person who loves to sit around and gossip.. it's possible people. I'm in nursing school right now and work as a tech and can say that without a doubt there are quite a few nurses who are not on their computer (therefore not charting) and sit there actually with earphones in watching HBO or Netflix.. some even leave their stations to go gossip at the front desk for 30 min at a time.. it's very possible that she is not wrong about their negligence and it seems wrong that many comments on here completely neglect (funny) her statements about how her coworkers are simply chit-chatting and not charting... you can tell the difference very easily.. So I'm done venting for this individual and I hope everything get better, honey! Just get through school and it will all be worth it :) Best of luck!

In my entire career, I have never observed a nurse having the time to do that. I'm not saying you are lying, but I am willing to bet that scenario is strikingly rare. Nurses are being given more and more patients; the powers that be are wringing everything possible out of them to the point that nurses are being burned out and disillusioned in depressing numbers.

The fact remains that when non nurses observe nurses, they often do not understand what exactly it is that they are seeing. Again, there are too many posts to count here written by new grads or CNAs turned LPN or RN who admit that they were incredibly (and mistakenly) judgmental about nurses, what the job entails, the knowledge required, the scope, the responsibility, and the stress involved in never quite being able to get it all done in the time allotted with the quality they desired. THAT's the norm, not the exception being described in the OP and in your own post.

Look through the numerous threads written by new grads about how overwhelmed they are, TO THEIR SURPRISE. In other words, they really thought they "understood" what the life of a nurse entailed, but when they actually had to walk that walk, they finally "realized" they didn't really know diddly.

missfreda · Nov 30, 2016

Well said!! I agree that CNA/Tech are underappreciated at times. I am an RN and was treated in the same manner when i was in the ER or ICU as a Tech. I was made to feel "beneath" the higher educated nurses. And was actually told that CNA's were uneducated. I was offended but motivated to become an LVN and 5 years later an RN! However, I made a personal vow to remember how I was treated, and to not treat the CNA/Tech or anyone that way. I regularly verbalize my appreciation for their help. And I do as much as I can to not burden them with tasks I can do. Nothing and no one is "beneath" me. I love nursing and the patients I provide care for. They are my purpose for working. But, I also respect my co-workers and the work they do. And, just for good measure...not every nurse is looking up meds on their phones! Especially, when they texting, face-booking and checking e-mails, while sitting behind the desk on the computer...So, I do know and understand what the paramedic is saying. There are known "floor" nurses and "desk" nurses who want the so-called "walkie-talkie" patients that were pre- arranged by the previous shift. Floor nurses are on their feet running all day and barely have time for a break. least of all lunch. "Desk" nurses are last to arrive to work, but first to leave. So, perhaps one should look at themselves and determine which type of nurse the paramedic may be dealing with! Hang in there Paramedic !

Horseshoe, BSN, RN · Dec 1, 2016

Well said!! I agree that CNA/Tech are underappreciated at times. I am an RN and was treated in the same manner when i was in the ER or ICU as a Tech. I was made to feel "beneath" the higher educated nurses. And was actually told that CNA's were uneducated. I was offended but motivated to become an LVN and 5 years later an RN!

Unless the CNA has a degree in another field, that statement happens to be true. I would be willing to bet that most CNAs have only a high school diploma. That is NOT to say that being uneducated is the same as being stupid, lacking worth as a person or team member, etc. Stating that someone lacking in formal education isn't real PC, but it's not necessarily false.

I was a tech while in nursing school, so I get it. I had a BS degree in another subject while I was a tech, so if someone had told me I was uneducated, I would have laughed. But the fact is that in general, it tends to be true in terms of higher education.

emmy27 · Dec 1, 2016

I've heard more than one tech express frustration that they felt like they were doing more than half of the tasks than the nurse. But remember, the tasks are the entirety of a tech's job descriptions, while they are only part of a nurse's job description. If a nurse and a tech are taking care of a patient together and they're both doing 50% of the tasks that the tech has the scope to perform, the nurse is doing a much larger total percentage of the patient care, because there are so many things outside the tech's scope.

When I hear a CNA or a tech claim they "do everything around here," while I do sympathize with the feeling (I think most of us feel overworked in healthcare- and for good reason)- it does make me think "this person does not really understand what the full scope of patient care entails" because they definitely are neither trained nor licensed to do everything- or even most things. Which is not to say that the things they do aren't vital and important- a patient left to sit in their own waste, labs or vitals not collected, call bells not answered, can all literally be fatal- but they are not nearly everything.

If techs (or for that matter paramedics) COULD do everything, the hospital would delightedly hire them in lieu of much more expensive nurses.

That they don't do that- that techs are considered a nice thing to have but nonessential (in the sense that you CAN run a unit or a shift without techs or paramedics, which is not an uncommon thing to happen) and nurses are essential to the operation of a unit (I can't tell you how many times I've held a patient who has an assigned bed till shift change because there wasn't yet a nurse to take the assignment upstairs, or even seen units closed due to nurse staffing issues) tells you that there IS work nurses are doing that techs aren't. Whether you can identify what it is or not.